Abernethy malformation

A 59-years-old woman presented to the emergency department with sudden onset of intermittent hematemesis and melena. The patient had a history of stage IV cervical cancer, sigmoid colostomy (because of rectovaginal fistula). A complete blood count showed normocytic anemia (79 g/l) and other laboratory evaluation showed the elevation of ammonia (38 µmol/l). The total bilirubin, transaminase and creatinine level were normal. Upper endoscopy revealed hemorrhage of esophageal varices that was stopped by local treatment with the combinations of spraying hemostatic and sclerotherapy (Figure 1). The CT-scan revealed no cirrhosis and liver lesion but did 10 show the absence of the portal vein with a complete extrahepatic shunt of the portal blood, considered Abernethy Malformation Ib (Figure 2,3), determined to be the possible reason of esophageal varices and megalosplenia. The old patient suffered from first-onset gastrointestinal bleeding and was diagnosed the only curative treatment is liver transplantation. This patient was stopped bleeding and transferred to cancer center for tumor therapy.